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Emergency Dept Visit Mod Mdm: What It Costs and What's Fair

CPT 99284  · Medicare rate: $118  · National avg charge: $2,197  · BillKarma data from 1 providers

Reviewed 2026-04-04  · Pricing data year: 2026

Emergency Dept Visit Mod Mdm (CPT 99284) is an outpatient procedure or diagnostic test performed in a hospital, clinic, or ambulatory care setting. It is typically completed in a single visit, and most patients return to normal activities the same day or within 24 hours.

Cost by Billing Grade

Grade Avg Hospital Charge Medicare Rate Est. Patient Cost* Hospitals
F $2,197 $118 $439 1

*Estimated patient cost assumes 20% coinsurance after deductible is met. Actual cost depends on your specific plan, deductible status, and network.

Cost Range Across Hospitals

Min: $2,197 Max: $2,197
Medicare: $118 Avg: $2,197
Grade A (≤2x Medicare) Grade B (2–3x) Grade C (3–5x) Grade D/F (5x+)

What This Procedure Typically Costs by Facility Type

Hospital
1 providers
$2,197 — $2,197 | Avg: $2,197 (18.6x Medicare)

Find Providers Near You for This Procedure

Showing 10 lowest-markup providers nationally across hospitals, surgery centers, and imaging centers. Enter ZIP code to compare local providers side by side.

Provider Type Location Grade Charge Benchmark Markup
AdventHealth South Overland Park Hospital Tampa, FL F $2,197 $118
Medicare OPPS
 18.6x

What Is a Fair Price for This Procedure?

Medicare pays $118 for Emergency Dept Visit Mod Mdm (CPT 99284). This rate is set by CMS based on the actual cost of delivering the procedure, including physician time, overhead, and equipment. It's the most reliable national benchmark for what the procedure is worth.

A hospital charging $236 (2x Medicare) or less earns an A billing grade — these are the most fairly priced facilities for this procedure. The national average charge is $2,197 (18.6x Medicare).

If your bill shows more than $355 (3x Medicare) for this procedure, it may be worth reviewing the charges carefully. Upload your bill to check →

Frequently Asked Questions

Is Emergency Dept Visit Mod Mdm covered by insurance?
Emergency Dept Visit Mod Mdm (CPT 99284) is generally covered by most insurance plans when medically necessary, but coverage varies by plan type and medical necessity criteria. Medicare pays $118 for this procedure. Always confirm your benefit coverage and any prior authorization requirements with your insurer before scheduling.
Why might I be billed separately for Emergency Dept Visit Mod Mdm by multiple providers?
When Emergency Dept Visit Mod Mdm is performed at a hospital outpatient facility, you may receive separate bills from the hospital (facility fee) and from the physician or specialist who performed or interpreted the procedure. This split billing—professional fee plus facility fee—is common. The national average hospital charge is $2,197, so make sure each individual bill reflects only the services that were actually provided.
How can I find out what my insurance will pay for Emergency Dept Visit Mod Mdm before I go?
Call the member services number on your insurance card and ask for a cost estimate or Explanation of Benefits preview for CPT 99284. Also confirm whether the facility you're considering is in-network. Medicare's reference rate for this procedure is $118—if a hospital charges significantly more, you may owe more out-of-pocket than expected even with insurance.

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